Symptoms - Pain

Reviewed by: HU Medical Review Board | Last reviewed: January 2017. | Last updated: May 2022

An estimated 75 percent of all cancer patients live with chronic pain. In lung cancer patients, acute pain is often felt in the chest and lumbar (lower back) regions of the body. Approximately 20 percent of patients with lung cancer present with chest pain at diagnosis, and pain increases in severity as lung cancer advances, with patients at later stages of the disease experiencing more pain.1

In a meta-analysis (assessment of multiple studies to combine data) of 32 research studies that involved patients with lung cancer, pain was experienced in 47 percent of patients. The majority of those had pain due to the cancer (73 percent), and 11 percent reported pain related to their cancer treatment. Another study of lung cancer patients receiving palliative care (pain/symptom management) found the prevalence of pain to be as high as 90 percent, with the most frequent sites for pain being the chest and lumbar spine.2

Types of pain in lung cancer

Pain is generally considered the most common symptom of lung cancer.  Pain is often caused by multiple factors and its management needs to be multi-disciplinary to address all these aspects. In cancer, pain can be characterized into two areas: acute pain and chronic pain. Acute pain is usually due to a definable injury or illness. Acute pain may be a secondary cause of cancer, such as a severe bleeding into a tumor, bone pain caused by a metastasis (spread of cancer), or abdominal pain caused by a metastasis that obstructs the bowel. Acute pain is usually experienced for a limited duration and is predictable. It is usually associated with clinical signs such as increased heart rate, high blood pressure, sweating, and pale skin.3

Chronic cancer pain may be a result of the same causes as acute pain but it is experienced for a much longer duration. Chronic pain can persist for more than 12 hours a day and often has a gradual or poorly defined onset. Approximately 75 percent of cancer patients live with chronic pain.3

Many cancer patients experience flares of pain despite using pain medications. These flares are called breakthrough cancer pain. Breakthrough pain greatly impairs a patient’s quality of life and can cause additional psychological burden.3

Causes of pain

The three most common causes of pain in patients with advanced lung cancer are:

  • Metastasis of lung cancer to the bones, which accounts for approximately 34 percent of lung cancer pain
  • Presence of a Pancoast tumor, located at the top of the lung close to the brachial plexus nerves and cervical sympathetic nerves, which accounts for approximately 31 percent of lung cancer pain
  • Spread of the cancer into the chest wall, accounting for approximately 21 percent of lung cancer pain3

Managing pain associated with lung cancer

Palliative care is a specialized field that aims to alleviate symptoms and maximize the patient’s quality of life. Palliative care does not focus on curing the disease or prolonging life, which is the goal of other cancer treatments, such as chemotherapy. However, palliative care is an important part of the patient’s treatment plan and encompasses physical symptoms, psychosocial distress, spiritual distress, and caregiver distress.1

The management of pain due to lung cancer may include a combination of medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioids (pain medications), and antidepressants. For metastases to the bone, radiation therapy and the use of bisphosphonates (drugs to help prevent bone breakdown) can alleviate pain. In addition, smoking cessation (stopping smoking) is recommended, as surveys have revealed that lung cancer patients who continue to smoke after diagnosis have a higher incidence of pain and other lung cancer complications than nonsmokers and those who quit smoking.2,3

Additional symptoms of lung cancer

While pain is the most common symptom of lung cancer, other symptoms include:

By providing your email address, you are agreeing to our privacy policy.